Provider Demographics
NPI:1366846289
Name:ASCROFT, ARIEL (PA)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:ASCROFT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 N BABCOCK ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7335
Mailing Address - Country:US
Mailing Address - Phone:321-241-6540
Mailing Address - Fax:
Practice Address - Street 1:402 N BABCOCK ST STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7335
Practice Address - Country:US
Practice Address - Phone:321-241-6540
Practice Address - Fax:321-428-4442
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant